Mt. Ascutney Hospital and Health Center

Author Affiliations: President (Ms Alfaro-LeFevre), Teaching Smart/Learning Easy, Stuart, Florida; Executive Director (Dr Boyer), Vermont Nurses in Partnership, Ascutney. The authors declare no conflicts of interest. Correspondence: Ms Alfaro-LeFevre, Teaching Smart/Learning Easy, 6161 SE Landing Way, #9, Stuart, FL 34997 ([email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonajournal.com).

Description: The base is located along NH Highway 31, 0.5 mile northwest of the intersection of NH Routes 9 and 31 at Hillsboro Lower Village, NH, and 1 mile southeast of Hillsboro Upper Village

Transportation on the Western Front, 1914–1918. Compiled by Colonel A. M. Henniker. With Introduction by Brigadier-General Sir James E. Edmonds, Director, Historical Section (Military Branch). [History of the Great War, based on Official Documents, by Direction of the Historical Section of the Committee of Imperial Defencel (London: H. M. Stationery Office; New York: British Library of Information. 1937. Pp. xxxiv, 531. Case of 14 Maps. $5.50, including maps.) Get access Transportation on the Western Front, 1914–1918. Compiled by Henniker A. M.Colonel. With Introduction by Brigadier-General Sir James E. Edmonds, Director, Historical Section (Military Branch). [History of the Great War, based on Official Documents, by Direction of the Historical Section of the Committee of Imperial Defence.] (London: H. M. Stationery Office; New York: British Library of Information. 1937. Pp. xxxiv, 531. Case of 14 Maps. $5.50, including maps.) William J. Wilgus William J. Wilgus Ascutney, Vermont Search for other works by this author on: Oxford Academic Google Scholar The American Historical Review, Volume 44, Issue 2, January 1939, Pages 386–388, https://doi.org/10.1086/ahr/44.2.386 Published: 01 January 1939

Introduction: Rwanda is an East African country of 12 million people that currently has 8 internists regularly performing diagnostic endoscopy. The country has four public referral hospitals with endoscopic capabilities. The Rwandan Society of Endoscopy (RSE) has a goal of expanding its coverage and increasing skills in therapeutic endoscopy. Prior case series of EGDs in Butare and Kigali have revealed major endoscopic diagnoses (i.e. ulceration, stricture and malignancy) in up to 40% of exams. Rwandan endoscopy week was a collaborative effort between a US gastroenterology team and members of the Rwandan Society of Endoscopy (RSE) who have a longstanding working relationship through a series of international physician exchanges. Methods: Six US GI physicians, two nurses, two technicians and a biomedical engineer worked in collaboration with members of the RSE (15 physicians and 18 nurses) for one week. Combined US/Rwandan teams were deployed to the four referral hospitals with endoscopic capabilities. GI consultation was done on the hundreds of patients referred for endoscopy to ensure appropriateness of the procedure. Patient demographic data, procedural indication and results were collected at the four sites with the Google Forms online tool. Results: Completed procedures included 200 EGDs, 39 colonoscopies and 5 ERCPs. 33% of EGDs revealed significant findings including peptic ulcer disease (16%), suspected gastric malignancy (4%), esophageal varices (4.5%), esophageal stenosis (2.5%) and benign-appearing gastric outlet obstruction (2.5%). Interventional procedures included esophageal variceal banding (7), placement of esophageal stents (2), balloon dilation of the esophagus (7), duodenum (1) and pylorus (1). Of those presenting for colonoscopy, the most common indications included hematochezia (41%), abdominal pain (31%) and constipation (28%). Significant findings on colonoscopy included hemorrhoid disease (23%) and suspected colorectal cancer (7.7%). Findings on ERCP included two patients with choledocholithiasis, one with a choledochoduodenal fistula and one with suspected cholangiocarcinoma. Conclusion: Our findings support the presence of a high burden of GI disease in Rwanda. Expanding Rwanda’s current capabilities to address this need is feasible, but will require many more physicians to be trained in diagnostic and therapeutic endoscopy. As the current Rwandan endoscopists are proficient in diagnostic endoscopy, advancement to therapeutic skills is a natural next step.

Abstract A need to improve the transitions of care between a small rural emergency department, a residential care facility and a primary care practice emerged early on in our work to become a level 2 accredited emergency department. One challenge is bringing together 3 partners all with distinct types of health records, unique foci of care and a variety of disciplines and workforce. This paper will focus on our journey of creating an individualized plan of care to help mitigate problems of poor communication with a focus on the 4Ms framework including: What Matters Most, Mobility, Medication and Mentation.

Read before the Massachusetts chapter of the American Physiotherapy Association, Boston, November 3, 1937.